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• W1994417785 abstract "The purpose of this work was to analyze possible clinical, biological, and dosimetric risk factors for treatment related pneumonitis (TRP) in patients with NSCLC. Clinical and dosimetric data were collected from 567 lung cancer patients treated with radiotherapy (RT) in our institution from 1999 to 2005. Grade ≥3 TRP was the normal tissue endpoint, censored at patient death or last follow-up for patients without TRP. Freedom from grade ≥3 TRP was calculated from the start of radiation to the date of first observation of grade ≥3 TRP. A Cox proportional hazards model with forward stepwise inclusion of variables was fitted to the data, using all clinical and dosimetric factors listed above (with or without univariate significance). Among the 567 patients available for analysis, the median time to TRP was 3.5 months after the start of RT (range 0.8 to 9.8 months), and the crude incidence of grade ≥3 TRP was 21% (118 cases), occurring mainly within the first 8 months post-therapy, when many patients succumbed to the disease. The estimated 6- and 12-month actuarial incidence of TRP was 20% (95% C.I. 17% to 24%) and 23% (95% C.I. 19% to 27%), respectively. In univariate analyses, smoking status (150 current smokers, 371 previous smokers, and 46 nonsmokers, p < 0.001), nodal status (104 node negative, 363 node positive, p = 0.029), volume of normal lung (median 3486 cc, range 1252 to 7870 cc, p = 0.003), percent of total lung represented by the GTV (median 3.5%, range <0.1% to 37.5%, p = 0.010), use of 4D-CT (N = 122, p = 0.048) and IMRT (N = 84, p = 0.034), mean dose to (normal) lung (median 21.1 Gy, range 2.1 Gy to 40.1 Gy, p < 0.001), relative volumes of normal lung rV5 to rV65, in increments of 5 Gy were associated with TRP with statistical significance by univariate analyses. In multivariate analyses (MV), higher rV30 (p < 0.001), nonsmoker (p = 0.001), and former smoker (p = 0.030) were the only 3 independent factors with increased risk of TRP. Each of the factors significant by univariate, analysis but not by MV analysis, is significantly associated (Mann-Whitney test) with differences in rV30. Further analysis demonstrated that the majority of non-smokers were healthy women who had smaller lung volume with adenocarcinoma, who received induction chemotherapy, and had higher mean V30-45, compared with smokers. The only clinical factor other than dose-volume factors that significantly impacts TRP risk is smoking status. Many different dose-volume factors were significantly associated with differences in time to TRP. Additional analysis is needed to identify what dose range of lung radiation is most important biologically. Based on the fits of the MV models, we can identify patient subgroups with markedly different risk, but we have not yet identified a high-risk group with an expected incidence of >50%. Therefore, there are undoubtedly other risk factors yet to be identified." @default.
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• W1994417785 date "2007-11-01" @default.
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• W1994417785 title "Non-Smokers and Former Smokers at Increased Risk for Treatment Related Pneumonitis (TRP) in Chemoradiation Therapy for Non-Small Cell Lung Cancer (NSCLC)" @default.
• W1994417785 doi "https://doi.org/10.1016/j.ijrobp.2007.07.109" @default.
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